Answering a senator who asked the AAFP and other members of the medical community to work on solutions to the problem of opioid addiction, the Academy assured him that family physicians have long been on the case.
Sen. Richard Durbin, D-Ill., addressed the issue in a strongly worded letter(www.durbin.senate.gov) to AAFP President Wanda Filer, M.D., M.B.A., of York, Pa., that encouraged family physicians to take a leadership role in solving a "widespread epidemic" of opioid addiction. He sent separate letters to the AMA, the American College of Emergency Physicians and the American Dental Association, and earlier had asked the pharmaceutical industry(www.durbin.senate.gov) to also take responsibility for the rise in opioid addiction.
"The AAFP, as a leading voice in the medical community, and your members must accept greater responsibility for the role you have played, and continue to play, in the ongoing prescription opioid epidemic," Durbin wrote to Filer. "The AAFP should take immediate action to reduce the number of opioids that are prescribed when not medically necessary."
- Sen. Richard Durbin, D-Ill., wrote a strongly worded letter asking family physicians to take a leadership role in solving the opioid addiction issue.
- The AAFP responded that it is actively participating in several continuing initiatives that focus on the issue
- The Academy also told the senator that 17,720 active members recorded 133,885 hours of CME on the use and prescription of opioids in 2014.
The Academy's reply, signed by Filer and Board Chair Robert Wergin, M.D., of Milford, Neb., pointed out that the AAFP is an active participant in ongoing national initiatives targeting the reduction of opioid abuse, including efforts sponsored by the White House, HHS, the CDC and the AMA Task Force to Reduce Opioid Abuse. Just last week, Filer reminded Academy members of pain management and opioid abuse resources that can aid them in their work.
"We agree that the medical profession, and family medicine especially, must lead the effort to find a comprehensive solution to this abuse of opioid medications," the Academy's letter stated. "As you noted, AAFP members work every day to improve the health of our patients. And we are deeply committed to the health of our communities, as well."
The letter told Durbin that opioids are not the first choice for family physicians treating patients with chronic pain. In fact, a 2012 survey of AAFP members showed they prescribed or recommended four other methods of treating nonmalignant chronic pain before opioids: physical and occupational therapy, oral nonsteroidal anti-inflammatory drugs, acetaminophen, and antidepressants. The high ratio of opioid prescriptions family physicians write, the AAFP said, is tied directly to the volume of patient visits they handle.
"We acknowledge that family physicians understandably write more than a quarter of all opioid prescriptions, but this is because they conduct as much as a quarter of all ambulatory office visits annually," the letter stated.
The AAFP also told Durbin that members are devoting time to staying current on the topic and that 17,720 active members recorded at least 133,885 hours of CME on the use and prescription of opioids in 2014. In addition, the AAFP is developing a free education course for members on appropriate prescribing of opioids.
In the letter, the Academy cited a 2012 position paper(15 page PDF) outlining the AAFP's longstanding efforts to minimize reliance on opioids. The paper is being revised and will be reissued in the coming months.
Although the AAFP agreed with Durbin that physicians should consult prescription drug databases before prescribing addictive medications, the letter cautioned that some state systems neither communicate with all prescribers in their area nor make timely updates to their information. Earlier this month, the AAFP urged the Department of Veterans Affairs to direct prescribers in their facilities to use state prescription drug monitoring programs.
Despite the brusque tone of Durbin's letter, the senator acknowledged that the problem of opioid abuse originates partly from a desire to help patients.
"We can also agree that since pain in many cases is a subjective element, doctors face a challenge in evaluating its existence or severity," Durbin wrote. "Nevertheless, the current situation regarding pain management is out of control."
The AAFP's response noted that sales of opioid pain relievers spiked in concert with the promotion of "pain as the fifth vital sign," which encouraged physicians to treat pain aggressively. This concept is being re-evaluated given the rise in opioid abuse.
Ending on an optimistic note, the AAFP pledged to work with Durbin.
"With your consistent leadership, we will make progress toward our common goal of eliminating the scourge of opioid drug abuse," the Academy's letter stated. "We will continue to provide relief to those patients afflicted with chronic and debilitating pain to help them remain functional members of the community."
Members of the House and Senate are now working to reach agreement on a final bill to address the issue.
Related AAFP News Coverage
AAFP Advises Lawmakers on Bills Intended to Curb Opioid Abuse